Qualitative research on chronic illness: The issue and the story

In the emerging era of treatable long-term sickness with relatively minor effects on physical capacity and life-style, it becomes vital for physicians who treat the chronically ill to know what the effects of technology and drugs are, not only in clinical terms, but also on their patients’ lives.

Abstract

The mechanism of action of disulfiram is not clear and recent systematic reviews have reached differing conclusions. The purpose of this research was to develop a conceptual model of the mechanisms that underpin the effective use of disulfiram in management of alcohol used disorder.Grounded theory was used, based on anonymized transcripts of in-depth interviews with 14 individual clients who experienced taking disulfiram for alcohol use disorder within the context of a specialized clinic setting from New Zealand.The central concept was that of abstinence being a psychosocial construction, with the taking of disulfiram, being a physical manifestation of the decision not to drink. The main subthemes included the importance of participants believing in the potential for disulfiram producing a negative reaction, the increased autonomy achieved by disulfiram removing the need to ruminate on drinking decisions, and the importance of external structure, routine, and social contact with others to support ongoing engagement with disulfiram therapy.The physiological effects of disulfiram, in particular its adverse reaction when combined with alcohol, explains only part of its effect on problem drinking behaviour. The act of taking a disulfiram pill is also partly symbolic of making an absolute decision not to drink for a short period, allowing people with alcohol use disorder to explore other options for managing life without alcohol. Drug trials involving disulfiram need to treat it not simply as pharmaceutical but as part of a complex psychosocial intervention conducted within a supportive social context.